Atherothrombosis refers to the formation of thrombus superimposed on preexisting atherosclerosis. This common pathophysiologic process results in morbid or fatal clinical ischemic events affecting the cerebral, coronary, or peripheral arterial circulation. Because the platelet is a pivotal mediator in the initiation and propagation of thrombus formation, antiplatelet drugs have emerged as key agents for prevention of recurrent ischemic events. However, there is controversy regarding choice of oral antiplatelet therapy in patients with vascular diseases (ie, ischemic stroke, coronary artery disease [CAD], and peripheral arterial disease [PAD]). While it has been established that aspirin prevents recurrent atherothrombotic events across a wide range of high-risk patients (relative risk reduction of approximately 25%), it is less clear if other antiplatelet agents, such as clopidogrel or dipyridamole, alone or added to aspirin, are more effective.
This uncertainty This uncertainty is reflected in clinical practice: neurologists prefer to use aspirin combined with dipyridamole for patients with transient ischemic attacks (TIAs) or ischemic strokes; cardiologists use aspirin, clopidogrel, or their combination for patients with CAD; and there are few data regarding optimal antiplatelet treatment choices in patients with PAD. This heterogeneity in clinical practice suggests that clinicians believe that each vascular condition is different.
Intra-arterial thrombus formation could be prevented; the major sequelae of atherosclerotic heart disease (myocardial infarction, unstable angina, and sudden cardiac death) as well as the majority of complications of percutaneous interventions could be prevented. Arterial thrombi, in contrast to venous thrombi, are platelet rich, making antiplatelet therapy central to their prevention. Until recently, our antiplatelet armamentarium was limited to aspirin. Today, we have a much wider selection of antiplatelet agents from which to choose, allowing us to optimize antiplatelet protection in specific clinical scenarios. Of course, the clinical benefits of platelet inhibition must be weighed against the associated risk of both surgical and nonsurgical hemorrhage.
The potential for increased hemorrhagic risk, especially in the surgical setting. In the months and years to come, it may not be unusual for a patient to require an urgent surgical procedure while being treated with two, or possibly three, different antiplatelet agents. Therefore, it is as important for the surgeon to understand the clinical benefits of antiplatelet therapy as it is for the cardiologist to appreciate the substantial risks associated with surgical bleeding.
Managing acute pathology of often relies on the addressing underlying pathology and symptoms of the disease. There is currently a need in the art for new compositions to treatment of Atherothrombosis.